Adaptation of a Best Practice Model for Recognition and Treatment of Postpartum Depression in a Private Obstetrics Practice

Thursday, 25 July 2013: 3:15 PM

Vicki E. Long, DNP, MSN, CNM, RN
School of Nursing, University of South Carolina Aiken, Aiken, SC

Learning Objective 1: The learner will be able to identify the incidence of postpartum depression.

Learning Objective 2: The learner will be able to describe adaptation of a Canadian protcol utilizing the Endiburgh Postpartum Depression Scale to an American private obstetrics practice.

Depression in women is tied to phases of reproduction, with the postpartum period highlighted as critical (Yonkers, et al., 2009). This period may be marred by feelings of low self-worth, disassociation with mothering, with the risk of maternal or fetal harm (Byatt, Simas, Lundquist, Johnson & Ziedonis, 2012; Nonacs, 2006).  In a meta-analysis done by Bennett and colleagues, the incidence of postpartum depression (PPD) ranged from 10 – 20 %, with 12% often quoted as average (Bennett, Einarson, Taddio, Koren & Einarson, 2004). Screening to identify at-risk women is used worldwide employing various tools, with the Edinburgh Postnatal Depression Scale (EPDS) being one of the most common (Horowitz, Murphy, Gregory & Wojick, 2011).

This project’s purpose was to determine whether an evidence-based practice guideline developed in Canada, utilizing the Edinburgh Postnatal Depression Scale (EPDS), could improve identification and management of at-risk women in a private obstetrical practice in the United States. Secondary aims were: (1) improve compliance in screening postpartum patients for depression, (2) improve staff documentation of and communication about PPD and (3) establish an ongoing protocol for screening and management. The protocol employed was developed by the Registered Nurses Association of Ontario (RNAO) for use in screening and managing postpartum depression (PPD) (Virani, et al., 2005).

 Two retrospective chart reviews were conducted, one of 170 postpartum patients pre-protocol initiation and one of 168 patients post protocol administration.  Upon initiating RNAO Guidelines, 96% of postpartum patients were screened by the EPDS. Comparing the identification of patients at risk for PPD before and after protocol initiation, the incidence of identified at-risk patients increased from 4.7% to 11%.  Protocol initiation resulted in statistically significant identification of more at-risk women. Staff documentation improved, and 100% of patients identified at risk had a follow-up plan.